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California children: Flavored medicine debate

If you’re a parent, you know how difficult it can be to get your kids to take medicine that tastes bad. 

Parents can remedy this by requesting their children’s prescription medicine to be flavored at the 3,000 pharmacies in California that are able to do so. But an unintended consequence of a 2019 law may make this long-standing practice run afoul with not only a nationwide standard, but also with the federal government.

A new bill this session aims to correct this by codifying that drug “compounding does not include… the addition of a flavoring agent to enhance palatability.”

But the California Board of Pharmacy is preparing to oppose the bill, despite a social media campaign (#MomsforFlavor) for the measure and supporters warning that a change would increase regulatory red tape.

The board had been scheduled to meet Tuesday and today, but canceled due the lack of a quorum so the debate will continue.

Let’s back up: In 2019, the state passed a law that required California pharmacists to prepare drugs in a way that met the rules outlined by the United States Pharmacopeia — a not-for-profit organization that sets standards for how drugs are prepared. This includes drug compounding, where pharmacists combine, mix or alter ingredients to meet the needs of individual patients.

At the time, Assemblymember Jacqui Irwin, a Democrat from Thousand Oaks and author of the law, said the goal was to ensure that Californians received drugs that met national health and safety standards, citing a 2012 multistate outbreak of fungal meningitis that killed 64 people due to the unsafe compounding of a steroid. The board approached her office, seeking to establish minimum standards for drug compounding and identifying U.S. Pharmacopeia as the baseline for compliance.

The status quo in California remained relatively fine until November, when the U.S. Pharmacopeia updated its guidelines to clarify that flavoring medicine falls in the scope of drug compounding. And because California must match its drug preparation standards by law, that would further regulate how pharmacists flavor medication, and may discourage them from offering the service altogether.

Thus, the bill, which passed the Assembly in March, and after some twists and turns in the Senate is now before the appropriations committee.

Irwin, a co-author of the bill, says she wants the board and key legislators to find a solution that protects consumer safety, while ensuring access to flavored medicine.

In a statement to CalMatters, Assemblymember Tom Lackey, a Republican from Palmdale and another co-author with Democrat Assemblymember Tina McKinnor of Inglewood, said that flavored medicines “have zero downside” and described the board’s opposition to the bill as “curious.”

  • Lackey: The board’s “position will put a chokehold on the supply of flavored medication because your neighborhood pharmacy will not adopt these unnecessary and onerous requirements…. Being a parent is tough enough. California’s absurd regulations should not make caring for a sick child more difficult than it already is.”

Though the board turned down my request for further comment, it has reason to play it safe and push back against the measure. The U.S. Pharmacopeia sets rules that can be enforced by state agencies as well as the federal Food and Drug Administration. If the proposal were to pass, the bill analysis warns of a “potential conflict” with federal requirements.

For the record: I got the timing wrong in Tuesday’s item about a proposal to pipe purified sewage water directly to drinking water supplies. As the full story explains, while the rules could take effect as soon as next April, it would take years for the necessary technology to be ready.


CalMatters’ new leader: After eight years, CalMatters has a new editor in chief — Kristen Go — and she spoke to Capitol Weekly about her vision, nonprofit news and other issues in an interview posted Monday. Read more about her career from our engagement team. 

CalMatters is growing: Our nonprofit newsroom is adding staffers to better inform Californians. We have several new openings, including for an economy reporter, a tech reporter and a state Capitol reporter (in partnership with Voice of San Diego). See all our opportunities and apply here.


AG investigates Butte County districts

Attorney General Rob Bonta addresses the media during a press conference announcing new gun legislation targeting the state's public carry laws on Feb. 2, 2023. Photo by Miguel Gutierrez Jr., CalMatters
Attorney General Rob Bonta at a press conference on Feb. 2, 2023. Photo by Miguel Gutierrez Jr., CalMatters

It was highly controversial when the conservative majority on the Butte County Board of Supervisors voted 3-2 for new districts that divided the Democratic stronghold of Chico into four separate districts.

It has since drawn the attention of Attorney General Rob Bonta, a Democrat who announced Tuesday he’s launching an investigation of the 2021 redistricting process that set Butte’s political boundaries for the next decade.

  • Bonta, in a statement: “In a democracy, every eligible voter deserves fair and equal representation. The allegations raised regarding the redistricting process in Butte County are serious and warrant a thorough investigation. We must ensure that the voting rights of all communities are protected and upheld.”

A department spokesperson said it hasn’t made any determinations yet regarding “specific complaints or allegations,” but that it is looking into whether the districts diluted the power of certain communities, thus violating state and federal voting rights laws.

As reported by local media, though the county hired a consulting firm to help draw the districts and held 10 public meetings before the December 2021 decision, the approved map was drafted by Supervisor Tod Kimelshue and his family. He and two other supervisors wanted two agricultural districts, one for farmers who rely on groundwater in the north and a second for farmers who use surface water in the south. 

But two other supervisors said splitting Chico unfairly disadvantages Democratic voters. “It is breaking up the communities of interest on the west side: students, low income, and Latinas,” said then-Supervisor Debra Lucero, who lost her seat under the new districts last year.  

This isn’t the only redistricting investigation Bonta has on his plate — the department is also investigating Los Angeles City council members after leaked audio showed the group conspiring to win reelection by drawing districts to their advantage.

Good government advocates say that elected officials shouldn’t decide their own districts.

This session, there’s a renewed push in the Legislature for independent redistricting in more cities and counties, similar to the statewide commission that draws the lines for congressional and state Assembly and Senate districts. A dozen new such commissions worked after the 2020 census.

Will highly-paid prison doctors strike?

A guard tower at the California Health Care Facility prison in Stockton on March 2, 2022. Miguel Gutierrez Jr., CalMatters
A guard tower at the California Health Care Facility prison in Stockton on March 2, 2022. Miguel Gutierrez Jr., CalMatters

There’s plenty of labor turmoil these days between state worker unions and the Newsom administration. 

Now, there’s even more: The union for physicians and psychologists working in California’s prisons have authorized a strike over pay (though they’re highly paid) and the use of contract doctors.

As CalMatters’ health reporter Kristen Hwang explains, during a time when more state workers say their wages aren’t enough to cover California’s high cost of living (especially in a state with scarce affordable housing), the union is demanding a 15% raise in the first year of a new contract. Their old contract with the state expired July 1, and they’ve been negotiating since March. 

Prison doctors and psychiatrists earn between $285,000 and $343,000 a year, but they argue that it doesn’t compare to temporary contractors who make twice the hourly rate. The pay differential is wide enough that some doctors quit to return as contractors, worsening another labor issue — increasing vacancy rates. 

Nader Wassef, a psychiatrist and chief of staff at Napa State Hospital, said his hospital has a 45% vacancy rate and hasn’t been fully staffed since 2014. In June, the vacancy rate among all psychiatrists was 35%. In an unsigned statement, Correctional Health Care Services reported a 20% vacancy rate for primary care doctors.

Meanwhile, the state is attempting to wrangle a $31 billion budget deficit, and is offering the prison doctors’ union a 2% raise for each of the next three years.

For members, that’s not enough. And while authorizing a strike does not necessarily mean workers will walk off the job right now, it could mean exactly that in the near future.

  • Wassef: “I am not going to claim poverty. What I’m trying to say is if we plan on getting trained, qualified psychiatrists to treat these patients, we are not going to get any because we are not competitive.”

Awkward political timing?

Former U.S. President and Republican presidential candidate Donald Trump looks on as he attends the Republican Party of Iowa's Lincoln Day Dinner in Des Moines, Iowa on July 28, 2023. Photo by Scott Morgan, Reuters
Former U.S. President Donald Trump in Des Moines, Iowa on July 28, 2023. Photo by Scott Morgan, Reuters

Shortly after noon on Tuesday, the California Republican Party blasted out an announcement that former President Donald Trump will headline its fall convention, giving the keynote speech on Sept. 29.

  • State GOP Chairperson Jessica Millan Patterson, in a letter: “President Trump last joined our CAGOP Convention in the spring of 2016, and we are honored to welcome him once again to address our delegates in Anaheim. This will be a historic event that you will not want to miss.”

Less than three hours later, news broke that Trump had been indicted on conspiracy charges related to the Jan. 6, 2021, storming of the U.S. Capitol and his efforts to overturn his 2020 election defeat.

In another time, perhaps, the timing might be awkward, even embarrassing.

But not now. 

After all, it had been widely expected that Trump would be indicted ever since he received a target letter from special counsel Jack Smith last month. And even with Trump already facing other indictments — including in the Mara-a-Lago classified documents case — the state GOP changed the delegate rules over the weekend to favor Trump in California’s presidential primary in March.

That didn’t stop California Democrats from trying to shame the state GOP.

And today, Patterson announced that Trump’s main rival so far for the nomination, Florida Gov. Ron DeSantis, will be the keynote speaker at the Sept. 29 dinner.

Meanwhile, Rep. Adam Schiff, one of three Democrats seeking the U.S. Senate seat being vacated by Dianne Feinstein, didn’t miss the chance to capitalize on a key part of his resume — lead manager in Trump’s first impeachment trial and a prominent member of the Jan. 6 select committee in Congress.

  • Schiff, in a statement: “These charges — based in large part on evidence we uncovered through our work on the January 6th Committee — and the trial that will follow, will put our democracy to a new test: can the rule of law be enforced against a former president and current candidate for president? For the sake of our democracy, we must hope that the answer is yes.”


CalMatters Commentary

CalMatters columnist Dan Walters: While California voters will face a slew of 2024 ballot measures, they’re all essentially replays of old ideological clashes.

Teens would be better equipped for life on social media with a bill to add media literacy to K-12 education, writes Abagail Moffatt, a senior at St. Mary’s High School in Stockton and co-founder of GetReal!, a student-led initiative tackling media literacy for teens and tweens.


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